Patients’ perspectives on social and goal-based comparisons regarding their diabetes health status

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Abstract

Objective

Social comparisons (ie, self-evaluation in comparison with others) influence patients’ perspectives of their disease and may impact motivation and health behavior; however, little is known about patients’ perspectives toward receiving such information in a clinical context (eg, from their doctor’s office or health system). This study aims to understand patients’ perspectives and anticipated responses to receiving social comparison information regarding measures of their diabetes-related health status (eg, A1C) and how receiving such information would compare with goal-based comparisons (ie, self-evaluation in comparison with goal).

Research design and methods

We conducted semistructured interviews with 25 patients with type 2 diabetes mellitus (T2DM) regarding social and goal-based comparisons involving their diabetes health status and qualitatively analyzed interviews for themes.

Results

We identified seven major themes: self-relevance, motivation, self-concept, emotions, information seeking, medical care, and self-care. Participants commonly anticipated increased motivation and improved health behaviors in response to both social and goal-based comparisons. Subthemes unique to social comparisons included belief that this information would be motivating by engaging some patients’ competitiveness, perception that this information was more ‘personalized’ than comparisons with a standard goal (eg, A1C<7), and desire to learn from individuals similar to oneself who were doing better.

Conclusions

Our findings provide significant insights into the anticipated response of patients with T2DM to receiving social and goal-based comparison information regarding their diabetes health status. Providing patients with diabetes with social and goal-based comparison information may affect motivation, mood, and self-concept in ways that may improve or sustain diabetes self-care behaviors for some patients.

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Most cited references 35

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Comparison processes in social judgment: mechanisms and consequences.

Thomas Mussweiler (2003)

This article proposes an informational perspective on comparison consequences in social judgment. It is argued that to understand the variable consequences of comparison, one has to examine what target knowledge is activated during the comparison process. These informational underpinnings are conceptualized in a selective accessibility model that distinguishes 2 fundamental comparison processes. Similarity testing selectively makes accessible knowledge indicating target-standard similarity, whereas dissimilarity testing selectively makes accessible knowledge indicating target-standard dissimilarity. These respective subsets of target knowledge build the basis for subsequent target evaluations, so that similarity testing typically leads to assimilation whereas dissimilarity testing typically leads to contrast. The model is proposed as a unifying conceptual framework that integrates diverse findings on comparison consequences in social judgment.

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Validation of Self-Reported Health Literacy Questions Among Diverse English and Spanish-Speaking Populations

Urmimala Sarkar, Dean Schillinger, Andrea Lopez … (2010)

Background Limited health literacy (HL) contributes to poor health outcomes and disparities, and direct measurement is often time-intensive. Self-reported HL questions have not been validated among Spanish-speaking and diverse English-speaking populations. Objective To evaluate three self-reported questions:1 “How confident are you filling out medical forms?”;2 “How often do you have problems learning about your medical condition because of difficulty understanding written information?”; and3 “How often do you have someone help you read hospital materials?” Answers were based on a 5-point Likert scale. Design This was a validation study nested within a trial of diabetes self-management support in the San Francisco Department of Public Health. Participants English and Spanish-speaking adults with type 2 diabetes receiving primary care. Methods Using the Test of Functional Health Literacy in Adults (s-TOFHLA) in English and Spanish as the reference, we classified HL as inadequate, marginal, or adequate. We calculated the C-index and test characteristics of the three questions and summative scale compared to the s-TOFHLA and assessed variations in performance by language, race/ethnicity, age, and education. Key Results Of 296 participants, 48% were Spanish-speaking; 9% were White, non-Hispanic; 47% had inadequate HL and 12% had marginal HL. Overall, 57% reported being confident with forms “somewhat” or less. The “confident with forms” question performed best for detecting inadequate (C-index = 0.82, (0.77-0.87)) and inadequate plus marginal HL (C index = 0.81, (0.76-0.86); p < 0.01 for differences from other questions), and performed comparably to the summative scale. The “confident with forms” question and scale also performed best across language, race/ethnicity, educational attainment, and age. Conclusions A single self-reported HL question about confidence with forms and a summative scale of three questions discriminated between Spanish and English speakers with adequate HL and those with inadequate and/or inadequate plus marginal HL. The “confident with forms” question or the summative scale may be useful for estimating HL in clinical research involving Spanish-speaking and English-speaking, chronically-ill, diverse populations. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1552-1) contains supplementary material, which is available to authorized users.

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Computer-Based Interventions to Improve Self-management in Adults With Type 2 Diabetes: A Systematic Review and Meta-analysis

Kingshuk Pal, Sophie V. Eastwood, Susan Michie … (2014)

OBJECTIVE Structured patient education programs can reduce the risk of diabetes-related complications. However, people appear to have difficulties attending face-to-face education and alternatives are needed. This review looked at the impact of computer-based diabetes self-management interventions on health status, cardiovascular risk factors, and quality of life of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS We searched The Cochrane Library, Medline, Embase, PsycINFO, Web of Science, and CINAHL for relevant trials from inception to November 2011. Reference lists from relevant published studies were screened and authors contacted for further information when required. Two authors independently extracted relevant data using standard data extraction templates. RESULTS Sixteen randomized controlled trials with 3,578 participants met the inclusion criteria. Interventions were delivered via clinics, the Internet, and mobile phones. Computer-based diabetes self-management interventions appear to have small benefits on glycemic control: the pooled effect on HbA1c was −0.2% (−2.3 mmol/mol [95% CI −0.4 to −0.1%]). A subgroup analysis on mobile phone–based interventions showed a larger effect: the pooled effect on HbA1c from three studies was −0.50% (−5.46 mmol/mol [95% CI −0.7 to −0.3%]). There was no evidence of improvement in depression, quality of life, blood pressure, serum lipids, or weight. There was no evidence of significant adverse effects. CONCLUSIONS Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control, and this effect was larger in the mobile phone subgroup. There was no evidence of benefit for other biological, cognitive, behavioral, or emotional outcomes.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open Diabetes Res Care

Journal ID (iso-abbrev): BMJ Open Diabetes Res Care

Journal ID (hwp): bmjdrc

Journal ID (publisher-id): bmjdrc

Title: BMJ Open Diabetes Research & Care

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2052-4897

Publication date Collection: 2018

Publication date (Electronic): 21 May 2018

Volume: 6

Issue: 1

Electronic Location Identifier: e000488

Affiliations

[1 ] departmentDivision of General Internal Medicine and Public Health , Vanderbilt University Medical Center , Nashville, Tennessee, USA

[2 ] Vanderbilt University School of Nursing , Nashville, Tennessee, USA

[3 ] departmentDepartment of Psychology , Vanderbilt University , Nashville, Tennessee, USA

[4 ] departmentQuality, Safety and Risk Prevention , Vanderbilt University Medical Center , Nashville, Tennessee, USA

Author notes

[Correspondence to ] Dr William Martinez; william.martinez@ 123456vanderbilt.edu

Author information

William Martinez http://orcid.org/0000-0002-3155-4386

Article

Publisher ID: bmjdrc-2017-000488

DOI: 10.1136/bmjdrc-2017-000488

PMC ID: 5969729

SO-VID: 44423929-9007-4d79-bf61-20ab08ebfe79

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 19 October 2017

Date revision received : 18 April 2018

Date accepted : 25 April 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;

Funded by: FundRef http://dx.doi.org/10.13039/100000062, National Institute of Diabetes and Digestive and Kidney Diseases;

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Keywords: diabetes,health behavior,social comparison,qualitative research

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Keywords: diabetes, health behavior, social comparison, qualitative research

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Patients’ perspectives on social and goal-based comparisons regarding their diabetes health status

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Most cited references 35

Comparison processes in social judgment: mechanisms and consequences.

Validation of Self-Reported Health Literacy Questions Among Diverse English and Spanish-Speaking Populations

Computer-Based Interventions to Improve Self-management in Adults With Type 2 Diabetes: A Systematic Review and Meta-analysis

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